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General NPI Number Information
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NPI Number | 1124097332
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Entity Type | Individual
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Provider Name | PHILIP CHARLES KRAUSE MD
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Gender | Male
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 1116 N 16TH ST., SUITE A
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City | LAFAYETTE
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State | IN
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Zip | 47904
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Country | US
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Telephone | 765-448-8000
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Fax | 765-448-8807
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Provider Business Mailing Address
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Address Line | 1200 W WHITE RIVER BLVD
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City | MUNCIE
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State | IN
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Zip | 47303-4988
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Country | US
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Telephone | 877-668-5621
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 01038669A
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License Number State | IN
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